Oral apparatuses and methods for mandibular jaw manipulation

ABSTRACT

An oral apparatus for mandibular jaw manipulation which in some embodiments may comprise: an upper tray configured to receive a plurality of maxillary teeth and a lower tray configured to receive a plurality of mandibular teeth. The upper tray may optionally have one or more upper anchor members configured as upper anchor members coupled to the upper tray. The lower tray may optionally have one or more lower anchor members configured as lower anchor members coupled to the lower tray. Each upper anchor member, which may be adjustable, may be configured to contact a lower anchor member, which may be adjustable, to adjust the positional relationship between the mandible and the maxilla of a mouth when a user wearing the oral apparatus closes their mouth to bring the upper and lower anchor members into contact with each other.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of Non-Provisional application Ser.No. 15/083,884, filed on Mar. 29, 2016, entitled “ORAL APPARATUSES ANDMETHODS FOR MANDIBULAR JAW MANIPULATION which is a continuation-in-partof U.S. Non-Provisional application Ser. No. 14/819,856, filed on Aug.6, 2015, entitled “ORAL APPARATUSES AND METHODS FOR MANDIBULAR JAWMANIPULATION”, both applications are hereby incorporated by reference inits entirety.

FIELD OF THE INVENTION

This patent specification relates to the field of orthodontics anddentistry including dental sleep medicine. More specifically, thispatent specification relates to systems and methods that alter themaxillary and mandibular dental relationship of a user.

BACKGROUND

The relationship between the mandible and maxilla can have a wide rangeof consequences. This relationship can affect chewing, biting, facialalignment, and even a person's propensity to snore. A Class II dentalrelationship is defined as the maxillary arch teeth protrudinganteriorly, or mesially of the mandibular teeth. A Class III dentalrelationship is defined as the mandibular arch teeth protrudinganteriorly, or mesially of the maxillary teeth.

These relationships are frequently corrected using orthodontic elastics,headgear, or intra-oral bite correctors (Functional Appliances) thatextend between the maxillary and mandibular dental sets. However,orthodontic elastics require frequent replacement. Headgear is oftenfound to be uncomfortable to the wearer and also has a decreased rate ofcompliance. Intra-oral bite correctors tend to be bulky anduncomfortable to the wearer. Additionally, these types of apparatusesare generally very noticeable, and therefore considered fairlyunaesthetic.

Therefore, a need exists for novel oral apparatuses and methods that areable to alter or direct the relationship between the mandible andmaxilla in an orthodontic manner. There also exists a need for noveloral apparatuses and methods that are able to alter the positionalrelationship between the mandible and maxilla to decrease snoring or beused in oral appliance therapy for Obstructive Sleep Apnea. There is afurther need for novel oral apparatuses and methods that are able toalter the relationship between the mandible and maxilla for Class IIdental relationship or Class III dental relationship correctiontreatment objectives. Finally, there exists a need for novel oralapparatuses and methods that are able to alter the relationship betweenthe mandible and maxilla in an aesthetic and comfortable manner.

BRIEF SUMMARY OF THE INVENTION

An oral apparatus comprising one or more adjustable anchor elementswhich is able to adjust or direct the positional relationship betweenthe mandible and maxilla is provided. In some embodiments, an oralapparatus may comprise an upper tray configured to receive a pluralityof maxillary teeth and a lower tray configured to receive a plurality ofmandibular teeth of a patient. The apparatus may further comprise one ormore anchor elements coupled to the upper and lower trays which may beadjustable thereby allowing portions of the adjustable anchor element tobe moved relative to the tray to which the adjustable anchor element iscoupled.

In further embodiments, the oral apparatus may comprise one or moreupper anchor members coupled to the upper tray which may be configuredas an adjustable upper anchor member. A first adjustable upper anchormember may be coupled to a first side of the upper tray and a secondadjustable upper anchor member may be coupled to a second side of theupper tray. The first adjustable upper anchor member may comprise amobile element movably coupled to a static element. The secondadjustable upper anchor member may comprise a mobile element movablycoupled to a static element. Each mobile element may comprise of anadjustable upper anchor member may comprise an upper contact surface. Afirst lower anchor member may be coupled to a first side of the lowertray, and a second lower anchor member may be coupled to a second sideof the lower tray. Each lower anchor member may comprise a lower contactsurface. The upper contact surface of the first adjustable upper anchormember may be configured to contact the lower contact surface of thefirst lower anchor member and the upper contact surface of the secondadjustable upper anchor member may be configured to contact the lowercontact surface of the second lower anchor member while the mouth is ina closed position to adjust the positional relationship between themandible and the maxilla of the mouth.

In still further embodiments, the oral apparatus may comprise one ormore lower anchor members which may be configured as an adjustable loweranchor member. A first adjustable lower anchor member may be coupled toa first side of the lower tray and a second adjustable lower anchormember may be coupled to a second side of the lower tray. The firstadjustable lower anchor member may comprise a mobile element movablycoupled to a static element. The second adjustable lower anchor membermay comprise a mobile element movably coupled to a static element. Eachmobile element of an adjustable lower anchor member may comprise a lowercontact surface. A first upper anchor member may be coupled to a firstside of the upper tray, and a second upper anchor member may be coupledto a second side of the upper tray. Each upper anchor member maycomprise an upper contact surface. The lower contact surface of thefirst adjustable lower anchor member may be configured to contact theupper contact surface of the first upper anchor member and the lowercontact surface of the second adjustable lower anchor member may beconfigured to contact the upper contact surface of the second upperanchor member while the mouth is in a closed position to adjust thepositional relationship between the mandible and the maxilla of themouth.

In still further embodiments, an oral apparatus may comprise one or moreupper anchor members which may be configured as an adjustable upperanchor member and/or one or more lower anchor members which may beconfigured as an adjustable lower anchor member.

In further embodiments, the first and second upper anchor members may bepositioned proximate to the maxillary molar teeth and may be configuredto contact with the first and second lower anchor members positionedproximate to the mandibular molar teeth to cause the mandible to moveforwards relative to the maxilla when the mouth is in a closed position.

In further embodiments, the first and second upper anchor members maycomprise an upper contact surface and an upper bite plane and the firstand second lower anchor members may comprise a lower contact surface anda lower bite plane.

In still further embodiments, the upper contact surface of the first andsecond upper anchor members may be configured to contact the lowercontact surface of the first and second lower anchor members while themouth is in a closed position.

According to another embodiment consistent with the principles of theinvention, a method of mandibular jaw manipulation with an oralapparatus comprising an adjustable anchor member, an upper tray, and alower tray is provided. The method may include the steps of: positioningthe lower jaw relative to the upper jaw in a therapeutic bite pattern;recording a digital scan of the upper and lower jaw positioning;positioning anchor members within the digital scan; converting thedigital scan to a three dimensional model comprising anchor members oneach jaw; fabricating an oral apparatus comprising an adjustable anchormember using the three dimensional model; and engaging the oralapparatus to the lower jaw and upper jaw of the patient.

According to a further embodiment consistent with the principles of theinvention, a method of mandibular jaw manipulation with an oralapparatus comprising an adjustable anchor member, an upper tray, and alower tray is provided. The method may include the steps of: determininga desired mandibular advancement distance (d1); fabricating an oralapparatus comprising an adjustable anchor member with a contact surfaceon a first tray and comprising an anchor member with a contact surfaceon a second tray; and moving the contact surface of the adjustableanchor member until desired mandibular advancement distance (d1) isachieved in a user wearing the oral apparatus.

BRIEF DESCRIPTION OF THE DRAWINGS

Some embodiments of the present invention are illustrated as an exampleand are not limited by the figures of the accompanying drawings, inwhich like references may indicate similar elements and in which:

FIG. 1 depicts a side perspective view of an example of an oralapparatus according to various embodiments described herein.

FIG. 2 illustrates a top plan view of an example of an upper element ofan oral apparatus according to various embodiments described herein.

FIG. 3 shows a top plan view of an example of a lower element of an oralapparatus according to various embodiments described herein.

FIG. 4 depicts a side perspective view of an example of an oralapparatus with the upper element engaged to the maxillary teeth of themaxillary jaw and with the lower element engaged to the mandibular teethof the mandibular jaw according to various embodiments described herein.

FIG. 5 illustrates an enlarged view of a portion of the example of anoral apparatus with the upper element engaged to the maxillary teeth ofthe maxillary jaw and with the lower element engaged to the mandibularteeth of the mandibular jaw depicted in FIG. 5 according to variousembodiments described herein.

FIG. 6 shows a flow chart of a method for forming an oral apparatusaccording to various embodiments described herein.

FIG. 7 depicts a flow chart of a method for performing a progressivemandibular jaw advancement according to various embodiments describedherein.

FIG. 8 illustrates a side perspective view of an example of an oralapparatus with the upper element engaged to the maxillary teeth of themaxillary jaw and with the lower element engaged to the mandibular teethof the mandibular jaw and the progressive advancement distance to alignthe mandibular jaw and maxillary jaw according to various embodimentsdescribed herein.

FIG. 9 shows a side perspective view of an alternative example of anoral apparatus comprising adjustable upper anchor members according tovarious embodiments described herein.

FIG. 10 depicts a side perspective view of an alternative example of anoral apparatus comprising adjustable lower anchor members according tovarious embodiments described herein.

FIG. 11 illustrates a top plan view of an example of an upper element ofan oral apparatus comprising adjustable upper anchor members accordingto various embodiments described herein.

FIG. 12 shows a top plan view of an example of a lower element of anoral apparatus comprising adjustable lower anchor members according tovarious embodiments described herein.

FIG. 13 depicts a top plan view of an example of an adjustable upperanchor member of an oral apparatus according to various embodimentsdescribed herein.

FIG. 14 illustrates a top plan view of an example of an adjustable loweranchor member of an oral apparatus according to various embodimentsdescribed herein.

FIG. 15 shows a flow chart of a method of mandibular jaw manipulationwith an oral apparatus comprising an adjustable anchor member accordingto various embodiments described herein.

DETAILED DESCRIPTION OF THE INVENTION

The terminology used herein is for the purpose of describing particularembodiments only and is not intended to be limiting of the invention. Asused herein, the term “and/or” includes any and all combinations of oneor more of the associated listed items. As used herein, the singularforms “a,” “an,” and “the” are intended to include the plural forms aswell as the singular forms, unless the context clearly indicatesotherwise. It will be further understood that the terms “comprises”and/or “comprising,” when used in this specification, specify thepresence of stated features, steps, operations, elements, and/orcomponents, but do not preclude the presence or addition of one or moreother features, steps, operations, elements, components, and/or groupsthereof.

For purposes of description herein, the terms “upper”, “lower”, “left”,“right”, “rear”, “front”, “side”, “vertical”, “horizontal”, andderivatives thereof shall relate to the invention as oriented in FIG. 1.However, one will understand that the invention may assume variousalternative orientations and step sequences, except where expresslyspecified to the contrary. Therefore, the specific devices and processesillustrated in the attached drawings, and described in the followingspecification, are simply exemplary embodiments of the inventiveconcepts defined in the appended claims. Hence, specific dimensions andother physical characteristics relating to the embodiments disclosedherein are not to be considered as limiting, unless the claims expresslystate otherwise.

To clarify the description of the invention certain dental terms shouldbe understood. Upper and lower teeth are termed maxillary and mandibularteeth, respectively. Front teeth are anterior teeth and back teeth areposterior teeth. Anterior teeth are incisors and are named centrals,laterals, and cuspids in order from the midline to the posterior. Theposterior teeth, from anterior to posterior, are first and secondpremolars; first, second, and third molars. Individual teeth aredescribed according to their surfaces. The distal surface is towards theback of the mouth and the mesial is the surface towards the front of themouth. The lingual or palatal surface is on the tongue side of theteeth. The labial or buccal surface is on the cheek or lip side of theteeth. The occlusal surface is where the maxillary and mandibular teethmeet.

Unless otherwise defined, all terms (including technical and scientificterms) used herein have the same meaning as commonly understood by onehaving ordinary skill in the art to which this invention belongs. Itwill be further understood that terms, such as those defined in commonlyused dictionaries, should be interpreted as having a meaning that isconsistent with their meaning in the context of the relevant art and thepresent disclosure and will not be interpreted in an idealized or overlyformal sense unless expressly so defined herein.

In describing the invention, it will be understood that a number oftechniques and steps are disclosed. Each of these has individual benefitand each can also be used in conjunction with one or more, or in somecases all, of the other disclosed techniques. Accordingly, for the sakeof clarity, this description will refrain from repeating every possiblecombination of the individual steps in an unnecessary fashion.Nevertheless, the specification and claims should be read with theunderstanding that such combinations are entirely within the scope ofthe invention and the claims.

New oral apparatuses and methods for mandibular jaw manipulation arediscussed herein. In the following description, for purposes ofexplanation, numerous specific details are set forth in order to providea thorough understanding of the present invention. It will be evident,however, to one skilled in the art that the present invention may bepracticed without these specific details.

The present disclosure is to be considered as an exemplification of theinvention, and is not intended to limit the invention to the specificembodiments illustrated by the figures or description below.

The present invention will now be described by example and throughreferencing the appended figures representing preferred and alternativeembodiments. FIGS. 1-4 illustrate an example of an oral apparatus (“theapparatus”) 100 according to various embodiments. In this example, theapparatus 100 comprises an upper element 11 with an upper tray 13 whichis configured to engage one or more of the maxillary teeth, and a lowerelement 12 with a lower tray 14 which is configured to engage one ormore of the mandibular teeth of a user.

An upper tray 13 may comprise a generally U-shaped arch with one or moretooth depressions which may extend into the upper tray 13. The shape ofthe arch preferably corresponds at least mainly to the maxillary dentalarch of the user. Each tooth depression may be configured to receive oneor more surfaces of a tooth such as the distal surface, mesial surface,palatal surface, the buccal surface, and/or the occlusal surface. Thetooth depressions are at least sufficiently wide and deep to be able tosnuggly or frictionally fit the teeth of the patient at least for themainly visible parts, thereby allowing the upper tray 13 to engage orsecure to one or more maxillary teeth when portions of the maxillaryteeth are received in the tooth depressions.

The upper element 11 may also comprise two upper anchor members 15, witha first upper anchor member 15 coupled to a first side of the upper tray13 which is configured to engage the occlusal surface of one or moreposterior maxillary teeth on a first side of the mouth and a secondupper anchor member 15 coupled to a second side of the upper tray 13above the portion of the upper tray 13 which is configured to engage theocclusal surface of one or more posterior maxillary teeth on a secondside of the mouth.

An upper anchor member 15 may be configured as a protrusion whichextends away from the upper tray 13 and therefore extends away from theocclusal surfaces of the maxillary teeth to which the upper tray 13 maybe engaged to. In some embodiments, an upper tray 13 may comprise twoupper anchor members 15, with a first upper anchor member 15 and asecond upper anchor member 15 coupled to opposite sides of the uppertray 13. For example and in some embodiments, a first upper anchormember 15 may be coupled to the upper tray 13 so that when the uppertray 13 is engaged to the maxillary teeth, the first upper anchor member15 may be positioned generally over the first maxillary molars such asthe maxillary first molar 301A (FIG. 4) and in some instances also overthe maxillary second molar 301B (FIG. 4) (second and third from the rearon FIG. 1) on a first side of the mouth while a second upper anchormember 15 may be coupled to the upper tray 13 so that when the uppertray 13 is engaged to the maxillary teeth, the second upper anchormember 15 may be positioned generally over the first maxillary molarssuch as the maxillary first molar 301A (FIG. 4) and in some instancesalso over the maxillary second molar 301B (FIG. 4) (second and thirdfrom the rear on FIG. 1) on a second side of the mouth. In otherembodiments, one or more upper anchor members 15 may be coupled toanywhere along the upper tray 13 and preferably coupled so that an upperanchor member 15 on a first side of the upper tray 13 may generallymirror the positioning of an upper anchor member 15 on a second side ofthe upper tray 13.

Each upper anchor member 15 may comprise an upper bite plane 17 whichmay form the portion of the upper tray 13 that extends farthest from theocclusal surfaces of the maxillary teeth when the upper tray 13 is beengaged to the maxillary teeth. Additionally, each upper anchor member15 may comprise an upper contact surface 19 which may generally form themesial surface of the upper anchor member 15 and extend from the upperbite plane 17 to the upper tray 13.

In some embodiments, the upper bite plane 17 and the upper contactsurface 19 may each comprise a generally planar shape with the upperbite plane 17 disposed substantially parallel to the occlusal surfacesof the maxillary teeth when the upper tray 13 is be engaged to themaxillary teeth. In other embodiments, an upper bite plane 17 and/or anupper contact surface 19 may comprise a concave, convex, or any othershape including combinations of shapes. Portions of the upper contactsurface 19 farthest from the upper bite plane 17 may be angled towardsthe upper bite plane 17 so that the upper contact surface 19 may becoupled to the upper bite plane 17 at upper medial corner 21 with upperanchor member corner angle 23 that is between 45 and 135 degrees. Infurther embodiments and as shown in FIGS. 4 and 5, an upper anchormember 15 may comprise a shape such as a block which generally resemblesan acute trapezoid prism with the portion of the upper contact surface19 farthest from the upper bite plane 17 acutely angled towards theupper bite plane 17 and the upper bite plane 17 forming the longer baseedge of the acute trapezoid. In alternative embodiments, an upper anchormember 15 may be configured with the shape of a rectangular prism,cuboid prism, or any other shape including combinations of shapes.

A lower tray 14 may comprise a generally U-shaped arch with one or moretooth depressions which may extend into the lower tray 14. The shape ofthe arch preferably corresponds at least mainly to the mandibular dentalarch of the user. Each tooth depression may be configured to receive oneor more surfaces of a tooth such as the distal surface, mesial surface,palatal surface, the buccal surface, and/or the occlusal surface. Thetooth depressions are at least sufficiently wide and deep to be able tosnuggly or frictionally fit the teeth of the patient at least for themainly visible parts, thereby allowing the lower tray 14 to engage orsecure to one or more mandibular teeth when portions of the mandibularteeth are received in the tooth depressions.

The lower element 12 may also comprise two lower anchor members 16, witha first lower anchor member 16 coupled to a first side of the lower tray14 which is configured to engage the occlusal surface of one or moreposterior mandibular teeth on a first side of the mouth and a secondlower anchor member 16 coupled to a second side of the lower tray 14above the portion of the lower tray 14 which is configured to engage theocclusal surface of one or more posterior mandibular teeth on a secondside of the mouth.

A lower anchor member 16 may be configured as a protrusion which extendsaway from the lower tray 14 and therefore extends away from the occlusalsurfaces of the mandibular teeth to which the lower tray 14 may beengaged to. In some embodiments, a lower tray 14 may comprise two loweranchor members 16, with a first lower anchor member 16 and a secondlower anchor member 16 coupled to opposite sides of the lower tray 14.For example and in some embodiments, a first lower anchor member 16 maybe coupled to the lower tray 14 so that when the lower tray 14 isengaged to the mandibular teeth 201, the first lower anchor member 16may be positioned generally over the mandibular second premolar 201P2and in some instances the mandibular first molar 201A (second and thirdfrom the rear on FIG. 1) on a first side of the mouth while a secondlower anchor member 16 may be coupled to the lower tray 14 so that whenthe lower tray 14 is engaged to the mandibular teeth, the second loweranchor member 16 may be positioned generally over the mandibular secondpremolar 201P2 and in some instances the mandibular first molar 201A(second and third from the rear on FIG. 1) on a second side of themouth. In other embodiments, one or more lower anchor members 16 may becoupled to anywhere along the lower tray 14 and preferably coupled sothat a lower anchor member 16 on a first side of the lower tray 14 maygenerally mirror the positioning of a lower anchor member 16 on a secondside of the lower tray 14.

Each lower anchor member 16 may comprise a lower bite plane 18 which mayform the portion of the lower tray 14 that extends farthest from theocclusal surfaces of the mandibular teeth when the lower tray 14 is beengaged to the mandibular teeth. Additionally, each lower anchor member16 may comprise a lower contact surface 20 which may generally form thedistal surface of the lower anchor member 16 and extend from the lowerbite plane 18 to the lower tray 14.

In some embodiments, the lower bite plane 18 and the lower contactsurface 20 may each comprise a generally planar shape with the lowerbite plane 18 disposed substantially parallel to the occlusal surfacesof the mandibular teeth when the lower tray 14 is be engaged to themandibular teeth. In other embodiments, a lower bite plane 18 and/or alower contact surface 20 may comprise a concave, convex, or any othershape including combinations of shapes. Portions of the lower contactsurface 20 farthest from the lower bite plane 18 may be angled towardsthe lower bite plane 18 so that the lower contact surface 20 may becoupled to the lower bite plane 18 at lower medial corner 22 with alower member corner angle 24 that is between 45 and 135 degrees. Infurther embodiments and as shown in FIGS. 4 and 5, a lower anchor member16 may comprise a shape which generally resembles an acute trapezoidprism with the portion of the lower contact surface 20 farthest from thelower bite plane 18 acutely angled towards the lower bite plane 18 andthe lower bite plane 18 forming the longer base edge of the acutetrapezoid. In alternative embodiments, a lower anchor member 16 may beconfigured with the shape of a rectangular prism, cuboid prism, or anyother shape including combinations of shapes.

As perhaps best shown in FIG. 4, a lower element 12 may comprise a loweranchor member 16 coupled to the lower tray 14 and the upper element 11may comprise an upper anchor member 15 coupled to the upper tray 13 withone or more portions of the upper anchor member 15 configured to contactone or more portions of the lower element 11 and one or more portions ofthe lower anchor member 16 configured to contact one or more portions ofthe upper element 12.

In some embodiments, the upper contact surface 19 of a first and asecond upper anchor member 15 may be configured to contact a portion ofthe lower contact surface 20 of a first and a second lower anchor member16 while the upper element 11 is engaged to the maxillary jaw, the lowerelement 12 is engaged to the mandibular jaw, and the mouth is in aclosed position. The upper contact surface 19 of the first upper anchormember 15 may be configured to contact a portion of the lower contactsurface 20 of the first lower anchor member 16 and the upper contactsurface 19 of the second upper anchor member 15 may be configured tocontact a portion of the lower contact surface 20 of the second loweranchor member 16 while the upper element 11 is engaged to the maxillaryjaw, the lower element 12 is engaged to the mandibular jaw, and themouth is in a closed position. Generally, a closed position may bedefined when the upper element 11 which is engaged to the maxillary jawand the lower element 12 which is engaged to the mandibular jaw are inproximity to each other, such as when portions of the upper element 11and lower element 12 are contacting each other.

In further embodiments, the upper bite plane 17 may be configured tocontact a portion of a lower tray 14 and/or the lower bite plane 18 maybe configured to contact a portion of an upper tray 13. The uppercontact surface 19 may extend from the upper tray 13 to intersect withthe upper bite plane 17 at an upper medial corner 21 to form upperanchor member corner angle 23. Upper anchor member corner angle 23 maycomprise any angle, such as between 45 and 135 degrees. The lowercontact surface 20 may extend from the lower tray 14 to intersect withthe lower bite plane 18 at a lower medial corner 22 to form lower membercorner angle 24. Lower member corner angle 24 may comprise any angle,such as between 45 and 135 degrees.

In some embodiments, the upper contact surface 19 of the first andsecond upper anchor members 15 may be oriented at a complementary angleto the lower contact surface 20 of the first and second lower anchormembers 16. The upper contact surface 19 of the first upper anchormember 15 may be oriented at a complementary angle to the lower contactsurface 20 of the first lower anchor member 16 while the upper contactsurface 19 of the second upper anchor member 15 may be oriented at acomplementary angle to the lower contact surface 20 of the second loweranchor member 16. Orienting the upper contact surface 19 of an upperanchor member 15 to the lower contact surface 20 of a lower anchormember 16 with a complementary angle may be accomplished when the upperanchor member corner angle 23 is complementary to the lower membercorner angle 24 thereby allowing the surface area contact between theupper contact surface 19 and the lower contact surface 20 to bemaximized. In further embodiments, the upper anchor member corner angle23 may be between 45 to 135 degrees and the lower member corner angle 24may be between 45 to 135 degrees. In still further embodiments, theupper anchor member corner angle 23 may be between 45 to 135 degrees andcomplementary to the lower member corner angle 24 which may be between45 to 135 degrees. In further embodiments, the upper anchor membercorner angle 23 may be less than 90 degrees and the lower member cornerangle 24 may be less than 90 degrees. In still further embodiments, theupper anchor member corner angle 23 may be less than 90 degrees andcomplementary to the lower member corner angle 24 which may be less than90 degrees.

The oral apparatuses 100 and methods for mandibular jaw manipulationdisclosed herein may be used to maintain or increase a mandibularadvancement distance, thereby adjusting the positional relationshipbetween a mandible and maxilla of a mouth. The mandibular advancementdistance describes the dental practitioner selected distance that themandibular jaw is to be moved relative to the maxillary jaw towards theanterior of the mouth. In some embodiments and as shown in FIG. 8, themandibular advancement distance may be broken up into a series ofprogressive advancement distances (d1) 400 to decrease the stress on apatient which can be caused by moving the mandible a large mandibularadvancement distance relative to the maxilla of a mouth. A user may weartwo or more, such as a series, of oral apparatuses 100 withprogressively increasing progressive advancement distances (d1) 400until the progressive advancement distance (d1) 400 of an apparatus 100is equal to the selected mandibular advancement distance. For example,if the selected mandibular advancement distance is three millimeters fora patient, the patient may first wear an apparatus 100 with aprogressive advancement distance (d1) 400 of one millimeters for aperiod of time, then wear an apparatus 100 with a progressiveadvancement distance (d1) 400 of two millimeters for a period of time,and finally wear an apparatus 100 with a progressive advancementdistance (d1) 400 of three millimeters for a period of time therebyeffectively moving the advancement of the mandibular in 1 mm incrementsas is currently a requirement for an oral appliance used in obstructivesleep Apnea.

As shown in FIG. 4, a first upper anchor member 15 may be configured tocontact a first lower anchor member 16 and a second upper anchor member15 is configured to contact a second lower anchor member 16 to adjustthe positional relationship between the mandible and the maxilla of amouth. Each upper anchor member 15 may be positioned on the upperelement 11 at an upper anchor member distance (d2 upper) 350 which isthe distance between a position in the posterior of the mouth, such asthe farthest posterior maxillary molar 302 or the distal surface offarthest posterior maxillary molar 302 a, and the upper anchor member15. Similarly, each lower anchor member 16 may be positioned on thelower element 12 at a lower member distance (d2 lower) 250 which is thedistance between a position in the posterior of the mouth, such as thefarthest posterior mandibular molar 202 or the distal surface offarthest posterior mandibular molar 202 a, and the lower anchor member16. In some embodiments, d2 lower 250 or d2 upper 350 may be generallyequal to a progressive advancement distance (d1) 400 (FIG. 8). In otherembodiments, d2 lower 250 and d2 upper 350 may both generally add up tothe progressive advancement distance (d1) 400. In further embodiments,the d2 upper 350 of an upper anchor member 15 may be greater than, equalto, or less than the d2 lower 250 of a lower anchor member 16.

It is important to note that d2 is a relative distance in thatincreasing the d2 upper 350 of a first upper anchor member 15 and/or ad2 lower 250 of a first lower anchor member 16 will increase themandibular advancement distance when the first upper anchor member 15and first lower anchor member 16 contact each other when the mouth is ina closed position. Conversely, decreasing the d2 upper 350 of a firstupper anchor member 15 and/or a d2 lower 250 of a first lower anchormember 16 will decrease the mandibular advancement distance when thefirst upper anchor member 15 and first lower anchor member 16 contacteach other when the mouth is in a closed position. Also in this manner,increasing the d2 upper 350 of a first upper anchor member 15 and/or ad2 lower 250 of a first lower anchor member 16 will increase theprogressive advancement distance (d1) 400, while decreasing the d2 upper350 of a first upper anchor member 15 and/or a d2 lower 250 of a firstlower anchor member 16 will decrease the progressive advancementdistance (d1) 400 when the first upper anchor member 15 and first loweranchor member 16 contact each other when the mouth is in a closedposition.

When the upper element 11 is engaged to the maxillary teeth and thelower element 12 is engaged to the mandibular teeth, the upper contactsurface 19 of an upper anchor member 15 on a first side of the mouth isconfigured to contact the lower contact surface 20 of a lower anchormember 16 on a first side of the mouth. Similarly, the upper contactsurface 19 of an upper anchor member 15 on a second side of the mouth isconfigured to contact the lower contact surface 20 of a lower anchormember 16 on the second side of the mouth. Preferably, a first loweranchor member 16 and second lower anchor member 16 may be coupled toopposing sides of the lower tray 14 in a generally mirroredconfiguration so that the first lower anchor member 16 may be positionedover approximately the same tooth or teeth on a first side of the mouthas the tooth or teeth the second lower anchor member 16 may bepositioned over on a second side of the mouth. As the two upper elements11 and lower elements 12 are brought together, such as when a userbrings their jaws together, the upper contact surfaces 19 may bepositioned to contact lower contact surfaces 20 thereby directing thelower jaw and mandibular teeth in a mesial direction relative to theupper jaw and maxillary teeth. In further embodiments, the movement ofthe upper element 11 towards the lower element 12, and therefore themovement of the mandibular jaw towards the maxillary jaw, such as whenthe user closes their mouth, may be arrested when a portion of the lowerbite planes 18 contact a portion of the upper tray 13 and/or when aportion of the upper bite planes 17 contact a portion of the lower tray14.

In some embodiments, the upper tray 13 may be configured to engage oneor more maxillary teeth and the lower tray 14 may be configured toengage one or more mandibular teeth, and as the upper element 11 andlower element 12 are brought together the upper contact surfaces 19 maybe positioned to contact lower contact surfaces 20 thereby directing thelower jaw in a mesial direction relative to the upper jaw for mandibularadvancement purposes such as to address a snoring condition of the user.For example, the therapeutic position of the lower jaw relative to theupper jaw to address a snoring problem may be recorded clinically, suchas a six millimeter advancement of the mandibular jaw relative to themaxillary jaw. Two upper anchor members 15 may be positioned on oppositesides of the upper element 11, each with a d2 upper 350, and two loweranchor members 16 may be positioned on opposite sides of the lowerelement 12, each with a d2 lower 250. The d2 upper 350 of each upperanchor member 15 and the d2 lower 250 of each lower anchor member 16,may be selected so that when a first upper anchor member 15 contacts afirst lower anchor member 16 and a second upper anchor member 15contacts a second lower member 16 when the mouth is in a closedposition, the mandibular jaw may be advanced approximately sixmillimeters.

In some embodiments, the upper tray 13 may be configured to engage oneor more maxillary teeth and the lower tray 14 may be configured toengage one or more mandibular teeth, and as the upper element 11 andlower element 12 are brought together the upper contact surfaces 19 maybe positioned to contact lower contact surfaces 20 thereby directing thelower jaw in a mesial direction relative to the upper jaw for mandibularadvancement purposes such as to address a snoring condition of the user.Additionally, the upper tray 13 may also be configured to engage one ormore maxillary teeth for orthodontic purposes such as to move one ormore maxillary teeth and/or the lower tray 14 may be configured toengage one or more mandibular teeth for orthodontic purposes such as tomove one or more mandibular teeth of the user. For example, the anchormembers 15, 16, may be positioned for a selected mandibular advancementdistance to alleviate snoring, while the upper tray 13 and/or lower tray14 may be configured to engage one or more teeth in an orthodonticmanner to move the one or more teeth while the user is wearing theapparatus 100 and the mouth is in a closed position.

FIG. 6 illustrates a flow chart of a method for forming an oralapparatus (“the method”) 500 according to various embodiments describedherein. In some embodiments, the method 500 may be used to form an oralapparatus for therapeutic mandibular advancement such as when a patientor user presents with SDB (sleep disorder Breathing) which may includeSnoring and Sleep Apnea, OSA (obstructive Sleep Apnea) which aretypically determined through a Sleep test and optionally toorthodontically move one or more teeth. The method 500 may start 510 andthe lower (mandibular) jaw may be positioned relative to the upper(maxillary) jaw in a therapeutic bite pattern for a user in step 520. Insome embodiments, the therapeutic bite pattern may position the lowerjaw relative to the upper jaw a required distance in order to addressthe condition of the user. In further embodiments, a sleep Physician maymake the diagnosis and dispense a prescription for an oral apparatus forsnoring or the treatment of Sleep Apnea to a dentist versed in DentalSleep Medicine comprising a required distance to advance the lower jawrelative to the upper jaw.

In step 530, a digital scan of upper and lower jaw positioning may berecorded. The positioning may include positioning data which describesthe therapeutic bite pattern and the dental arches of the user. In someembodiments, the positioning data may be recorded by a digital intraoralimpression scanner such as an iTero® Intraoral scanner or the like. Infurther embodiments, the positioning data may be recorded as a STL(STereoLithography) file format such as is native to thestereolithography CAD software created by 3D Systems. In otherembodiments, the positioning data may be recorded in any file formatwhich may describe the surface geometry of a three-dimensional object,such as the upper and lower jaw positioning to achieve the therapeuticbite pattern.

In step 540, one or more anchor members 15, 16, (FIGS. 1-4) may bepositioned within the digital scan. In some embodiments, one or moreanchor members 15, 16, may be positioned within the digital scan byimporting the digital scan into a 3-D scanning reverse engineeringsoftware program such as Orchestrate Orthodontic Technologies® scanningreverse engineering software. Using the software program, one or moreupper anchor members 15 may be positioned proximate to one or moremaxillary teeth 301 on one or more sides of the upper or maxillary jaw300, with each upper anchor member 15 comprising a d2 upper 350 (FIG.4). Also using the software program, one or more lower anchor members 16may be positioned proximate to one or more mandibular teeth 201 on oneor more sides of the lower or mandibular jaw 200, with each lower anchormember 16 comprising a d2 lower 250 (FIG. 4). The positioning of theanchor members 15, 16, may be selected so that the upper contact surface19 of an upper anchor member 15 on a first side of the mouth isconfigured to contact the lower contact surface 20 of a lower anchormember 16 on a first side of the mouth. Similarly, the upper contactsurface 19 of an upper anchor member 15 on a second side of the mouth isconfigured to contact the lower contact surface 20 of a lower anchormember 16 on the second side of the mouth. Preferably, a first loweranchor member 16 and second lower anchor member 16 may be coupled toopposing sides of the lower tray 14 in a generally mirroredconfiguration so that the first lower anchor member 16 may be positionedover approximately the same tooth or teeth on a first side of the mouthas the tooth or teeth the second lower anchor member 16 may bepositioned over on a second side of the mouth. As the upper anchormembers 15 and lower anchor members 16 are brought together, such aswhen a user brings their jaws together in a closed position, the fourcontact surfaces 19, 20, may contact each other thereby directing thelower jaw and mandibular teeth in a mesial direction relative to theupper jaw and maxillary teeth. In addition to the selectable positioningof the anchor members 15, 16, the size and dimension of each anchormember 15, 16 may be adjusted and personalized for each patient. By wayof non-limiting example, a sleep patient suffering from jaw musclesoreness may call for reduced vertical dimensions of each anchor member15, 16 (i.e. the distance between the bite planes 17, 18 of the anchormembers 15, 16 and the trays 13, 14) while a patient suffering fromexcessive snoring may call for an increase in vertical dimensions ofeach anchor member 15, 16 (i.e. the distance between the bite planes 17,18 of the anchor members 15, 16 and the trays 13, 14).

Next in step 550, the digital scan with positioned anchor members 15,16, may be converted to a 3-D model comprising one or more anchormembers 15, 16, on each jaw. The 3-D model may comprise one or moreupper anchor members 15 positioned proximate to one or more maxillaryteeth on one or more sides of the upper jaw, and one or more loweranchor members 16 positioned proximate to one or more mandibular teethon one or more sides of the lower jaw. In some embodiments, the digitalscan with positioned anchor members 15, 16, may be converted to a 3-Dmodel with additive manufacturing, such as with Three-dimensionalprinting or 3D printing. In further embodiments, the 3-D model maycomprise one or more anchor members 15, 16, positioned on a threedimensional model of each jaw. In yet further embodiments, the digitalscan 550 with anchor members 15, 16 may be used as a digital image fileto be used by a mill or otherwise fabricate the apparatus 100 directlyusing the digital rendered image file without fabricating a 3-D model(i.e. bypassing part of step 560) with said apparatus 100 being thenworn by a patient.

In some embodiments, an oral apparatus 100 may be first be fabricatedfirst using the 3-D model (step 560) which comprises one or more upperanchor members 15 positioned proximate to one or more maxillary teeth onone or more sides of the upper jaw, and one or more lower anchor members16 positioned proximate to one or more mandibular teeth on one or moresides of the lower jaw. In some embodiments, the apparatus 100 may befabricated by thermal-forming a suitable oral plastic, such as Biocryl®or any other dental splint material, over the each jaw of the 3-D model.Once formed over the 3-D model, portions of the thermal formed materialwhich are molded around the mandibular teeth of the 3-D model, therebyforming depressions to receive the mandibular teeth of the user may alsoform the lower tray 14, while portions of the thermal formed materialwhich are molded around the anchor members of the 3-D model lower jawmay form the lower anchor members 16 coupled to the lower tray 14.Similarly, once formed over the 3-D model, portions of the thermalformed material which are molded around the maxillary teeth of the 3-Dmodel, thereby forming depressions to receive the maxillary teeth of theuser may also form the upper tray 13, while portions of the thermalformed material which are molded around the anchor members of the 3-Dmodel upper jaw may form the upper anchor members 15 coupled to theupper tray 13. In still further embodiments, the fabrication of step 560may include final or routine adjustments by the dental practitioner toensure a proper and comfortable fit for the user. After step 560, themethod 500 may finish 570.

FIG. 7 illustrates a flow chart of a method for performing a progressivemandibular jaw advancement (“the method”) 600 according to variousembodiments described herein. In some embodiments, the method 600 may beused to progressively achieve a therapeutic mandibular advancement suchas when a patient or user presents with SDB (sleep disorder Breathing)which may include Snoring and Sleep Apnea, OSA (obstructive Sleep Apnea)which are typically determined through a Sleep test and optionally toorthodontically move one or more teeth. The therapeutic mandibularadvancement may be divided into any number of increments to produce adesired progressive mandibular advancement distance (d1) 400. In thisembodiment, the upper anchor members 15 remain in position proximate tothe maxillary molars, while the lower anchor members 16 are positionedproximate to different mandibular molars relative to the different lowerelements 12 in a series of lower elements 12. In alternativeembodiments, the lower anchor members 16 may remain in positionproximate to the mandibular molars, while the upper anchor members 15may be positioned proximate to different maxillary molars relative tothe different upper elements 11 in a series of upper elements 11. Infurther alternative embodiments, the upper anchor members 15 may bepositioned proximate to different maxillary molars relative to thedifferent upper elements 11 in a series of upper elements 11 and thelower anchor members 16 are positioned proximate to different mandibularmolars relative to the different lower elements 12 in a series of lowerelements 12 so that the user or patient may wear a series of lowerelements 12 and a series of upper elements 11 in order to achievemandibular advancement.

The method 600 may start 610 and the desired progressive mandibularadvancement distance (d1) 400 may be determined or selected for thepatient in which the lower (mandibular) jaw may be positioned relativeto the upper (maxillary) jaw in a therapeutic bite pattern for a patientin step 620. As shown in FIG. 8, the progressive mandibular advancementdistance (d1) 400 may be described as the distance the lower jaw 200 isto be advanced forward to allow the alignment of the teeth of the upperjaw 300 with the lower jaw 200 to produce a therapeutic bite pattern. Insome embodiments, the desired progressive mandibular advancementdistance (d1) 400 may produce a therapeutic bite pattern which mayposition the lower jaw 200 relative to the upper jaw 300 a requireddistance in order to address the condition of the user. In furtherembodiments, a sleep Physician may make the diagnosis and dispense aprescription for an oral apparatus for snoring or the treatment of SleepApnea to a dentist versed in Dental Sleep Medicine comprising a requireddistance to advance the lower jaw relative to the upper jaw.

In step 630, an upper element 11 may be formed. The upper element 11 maycomprise a first upper anchor member 15 and a second upper anchor member15 coupled to the upper tray 13 to be positioned proximate to one ormore of the maxillary molar teeth. The upper element 11 may beoptionally formed according to the method 500 of described in FIG. 6.

In step 640, a series of lower elements 12 with progressively increasinglower member distance (d2 lower) 250 (FIG. 4) may be formed. The lowerelement 12 may comprise a first lower anchor member 16 and a secondlower anchor member 16 coupled to the lower tray 14 to be positionedproximate to one or more of the mandibular molar teeth. In someembodiments, a series of lower elements 12 may comprise two or morelower elements 12, each with progressively increasing d2 lower 250relative to another lower element 12, with at least one lower element 12of the series comprising a d2 lower 250 generally equal to the desiredprogressive mandibular advancement distance (d1) 400 (FIG. 8). Forexample, the selected mandibular advancement distance for a patient maybe six millimeters. The therapeutic mandibular advancement may bedivided into three increments to produce a desired progressivemandibular advancement distance (d1) 400 of two millimeters. In thisexample, the series of lower elements 12 may comprise three lowerelements 12, with the first lower element 12, comprising a d2 lower 250of two millimeters, the second lower element 12, comprising a d2 lower250 of four millimeters, and the third lower element 12, comprising a d2lower 250 of six millimeters. In further embodiments, any desiredprogressive advancement distance (d1) 400 may be used and any number oflower elements 12, each with any desired d2 lower 250 may be used.

Next, in step 650 the user or patient may wear the upper element 11 andthe lower element 12 with the smallest d2 lower 250 (FIG. 4) for aperiod of time. Using the current example, the user may wear the upperelement 11 and the lower element 12 with the smallest d2 lower 250 oftwo millimeters for a period of time. The period of time may be selectedby the practitioner. A first upper anchor member 15 may be configured tocontact a first lower anchor member 16 and a second upper anchor member15 may be configured to contact a second lower anchor member 16 toadjust the positional relationship between the mandible 200 and themaxilla 300 of a mouth to a distance equal to the therapeutic mandibularadvancement when the mouth is in a closed position.

Next, in step 660 the user or patient may wear the upper element 11 andthe lower element 12 with a d2 lower 250 (FIG. 4) that is larger thanthe d2 lower 250 of the previously worn lower element 12 for a period oftime. Using the current example, the user may wear the upper element 11and the lower element 12 with the d2 lower 250 of four millimeters for aperiod of time. The period of time may be selected by the practitioner.

In decision block 670, the practitioner may determine if the desiredtherapeutic mandibular advancement has been achieved. If the desiredtherapeutic mandibular advancement has not been achieved, the method 600may proceed to step 660 and the user or patient may wear the upperelement 11 and the lower element 12 with a d2 lower 250 that is largerthan d2 lower 250 of the previously worn lower element 12 for a periodof time. Using the current example, the user may wear the upper element11 and the lower element 12 with the d2 lower 250 of six millimeters fora period of time. The period of time may be selected by thepractitioner.

Once the desired therapeutic mandibular advancement has been achieved,such as when the d2 lower 250 FIG. 4) is generally equal to the desiredtherapeutic mandibular advancement and/or the progressive advancementdistance (d1) 400 (FIG. 8), the method 600 may finish 680.

FIGS. 9 and 10 illustrate alternative embodiments of an oral apparatus100 comprising one or more adjustable anchor elements which is able toadjust or direct the positional relationship between the mandible andmaxilla. In some embodiments, an oral apparatus 100 may comprise anupper tray 13 configured to receive a plurality of maxillary teeth 301and a lower tray 14 configured to receive a plurality of mandibularteeth 201 of a patient. The apparatus 100 may further comprise one ormore anchor elements 15A, 16A, coupled to the upper 13 and lower 14trays which may be adjustable thereby allowing portions of theadjustable anchor element 15A, 16A, to be moved relative to the tray 13,14, to which the adjustable anchor element 15A, 16A, is coupled.

FIG. 9 shows a side perspective view of an alternative example of anoral apparatus 100 comprising adjustable upper anchor members 15Aaccording to various embodiments described herein. In this example, theoral apparatus 100 may comprise an upper tray 13 configured to receive aplurality of maxillary teeth and a lower tray 14 configured to receive aplurality of mandibular teeth of a patient. A first adjustable upperanchor member 15A may be coupled to a first side of the upper tray 13.The first adjustable upper anchor member 15A may comprise a mobileelement 51 movably coupled to a static element 52. A second adjustableupper anchor member 15A may be coupled to a second side of the uppertray 13. The second adjustable upper anchor member 15A may comprise amobile element 51 movably coupled to a static element 51. Each mobileelement 51 may comprise of an adjustable upper anchor member 15A maycomprise an upper contact surface 19. A first lower anchor member 16 maybe coupled to a first side of the lower tray 14, and a second loweranchor member 16 may be coupled to a second side of the lower tray 14.Each lower anchor member 16 may comprise a lower contact surface 20. Theupper contact surface 19 of the first adjustable upper anchor member 15Amay be configured to contact the lower contact surface 20 of the firstlower anchor member 16 and the upper contact surface 19 of the secondadjustable upper anchor member 15A may be configured to contact thelower contact surface 20 of the second lower anchor member 16 while themouth is in a closed position to adjust the positional relationshipbetween the mandible and the maxilla of the mouth.

FIG. 10 shows a side perspective view of an alternative example of anoral apparatus 100 comprising adjustable lower anchor members 16Aaccording to various embodiments described herein. In this example, theoral apparatus 100 may comprise an upper tray 13 configured to receive aplurality of maxillary teeth and a lower tray 14 configured to receive aplurality of mandibular teeth of a patient. A first adjustable loweranchor member 16A may be coupled to a first side of the lower tray 14.The first adjustable lower anchor member 16A may comprise a mobileelement 51 movably coupled to a static element 52. A second adjustablelower anchor member 16A may be coupled to a second side of the lowertray 14. The second adjustable lower anchor member 16A may comprise amobile element 51 movably coupled to a static element 51. Each mobileelement 51 of an adjustable lower anchor member 16A may comprise a lowercontact surface 20. A first upper anchor member 15 may be coupled to afirst side of the upper tray 13, and a second upper anchor member 15 maybe coupled to a second side of the upper tray 13. Each upper anchormember 15 may comprise an upper contact surface 19. The lower contactsurface 20 of the first adjustable lower anchor member 16A may beconfigured to contact the upper contact surface 19 of the first upperanchor member 15 and the lower contact surface 20 of the secondadjustable lower anchor member 16A may be configured to contact theupper contact surface 19 of the second upper anchor member 15 while themouth is in a closed position to adjust the positional relationshipbetween the mandible and the maxilla of the mouth.

In some embodiments and as shown in FIGS. 9-14, an oral apparatus 100may comprise one or more anchor elements which may be adjustable therebyallowing the contact surface 19, 20, of the adjustable anchor element tobe moved relative to the tray 13, 14 to which the adjustable anchorelement is coupled. In further embodiments, an upper anchor member 15may be configured as an adjustable upper anchor member 15A. In furtherembodiments, a lower anchor member 16 may be configured as an adjustablelower anchor member 16A. In still further embodiments, an apparatus 100may comprise one or more upper anchor members 15 which may be configuredas an adjustable upper anchor member 15A and/or one or more lower anchormembers 16 which may be configured as an adjustable lower anchor member16A.

As perhaps best shown in FIGS. 9, 11, 13, an adjustable upper anchormember 15A may comprise a mobile element 51 movably coupled to a staticelement 52. The static element 52 of an adjustable upper anchor member15A may be fixedly coupled to the upper tray 13 of an upper element 11.The mobile element 51 of an adjustable upper anchor member 15A may bemovably coupled to the static element 51 and/or movably coupled to theupper tray 13 of an upper element 11. By movably coupling a mobileelement 51 to a static element 52 and/or to the upper tray 13 of anupper element 11, the position of the mobile element 51 relative to thestatic element 52 and/or to the upper tray 13 of an upper element 11 maybe changed. In preferred embodiments, a mobile element 51 of anadjustable upper anchor member 15A may be movably coupled to the staticelement 51 and/or movably coupled to the upper tray 13 of an upperelement 11 so that the mobile element 51 may be moved in an anteriordirection and/or in a posterior direction relative to the maxillaryteeth of a patient which may be received in the upper tray 13.

Each upper anchor member 15 configured as an adjustable upper anchormember 15A may comprise an upper contact surface 19 which may generallyform the mesial surface of the adjustable upper anchor member 15A andwhich may extend from the upper bite plane 17 to the upper tray 13.Preferably, the upper contact surface 19 of an adjustable upper anchormember 15A on a first side of the upper tray 13 may contact the lowercontact surface 20 of a lower anchor member 16, 16A, on a first side ofthe lower tray 14 when the jaw of a patient wearing an oral apparatus100 is closed. The upper contact surface 19 of an adjustable upperanchor member 15A may be formed onto the mesial or anterior surface ofthe mobile element 51 of the adjustable upper anchor member 15A. Bymoving the mobile element 51 of an adjustable upper anchor member 15A ina posterior direction, the upper contact surface 19 of the adjustableupper anchor member 15A may be moved in a posterior direction.Conversely, by moving the mobile element 51 of an adjustable upperanchor member 15A in an anterior direction, the upper contact surface 19of the adjustable upper anchor member 15A may be moved in an anteriordirection.

Additionally, each upper anchor member 15 configured as an adjustableupper anchor member 15A may comprise an upper bite plane 17 which mayform the portion of the upper tray 13 that extends farthest from theocclusal surfaces of the maxillary teeth when the upper tray 13 is beengaged to the maxillary teeth. In some embodiments, the upper biteplane 17 of an adjustable upper anchor member 15A may be formed by anupper static bite plane 17A and/or an upper mobile bite plane 17B.Generally, a mobile element 51 of an adjustable upper anchor member 15Amay comprise an upper mobile bite plane 17B which may form the portionof the mobile element 51 of the adjustable upper anchor member 15A thatextends farthest from the occlusal surfaces of the maxillary teeth whenthe upper tray 13 is be engaged to the maxillary teeth. Likewise, astatic element 52 of an adjustable upper anchor member 15A may comprisean upper static bite plane 17A which may form the portion of the mobileelement 51 of the adjustable upper anchor member 15A that extendsfarthest from the occlusal surfaces of the maxillary teeth when theupper tray 13 is be engaged to the maxillary teeth. Optionally, theupper mobile bite plane 17B and the upper static bite plane 17A mayextend the substantially the same distance from the occlusal surfaces ofthe maxillary teeth when the upper tray 13 is be engaged to themaxillary teeth.

In preferred embodiments, the mobile element 51 of an adjustable upperanchor member 15A may be anterior to the static element 52 and thestatic element 52 may be posterior to the mobile element 51. Anadjustable upper anchor member 15A may be positioned proximate to themaxillary molar teeth 301 and configured to contact with a lower anchormember 16, 16A, positioned proximate to the mandibular teeth 201, suchas to the mandibular second premolar teeth 201P2, to cause the mandibleto move forwards relative to the maxilla when the mouth is in a closedposition and the adjustable upper anchor member 15A is contacting thelower anchor member 16, 16A. Portions of the upper contact surface 19 ofan adjustable upper anchor member 15A farthest from the upper bite plane17, formed by an upper static bite plane 17A and/or an upper mobile biteplane 17B, may be angled towards the upper bite plane 17 so that theupper contact surface 19 may be coupled to the upper bite plane 17 atupper medial corner 21 with upper anchor member corner angle 23 that isbetween 45 and 135 degrees. In further preferred embodiments, the upperanchor member corner angle 23 of an adjustable upper anchor member 15Amay be less than or equal to 90 degrees.

Similar to an adjustable upper anchor member 15A and as perhaps bestshown in FIGS. 10, 12, 14, an adjustable lower anchor member 16A maycomprise a mobile element 51 movably coupled to a static element 52. Thestatic element 52 of an adjustable lower anchor member 16A may befixedly coupled to the lower tray 14 of a lower element 12. The mobileelement 51 of an adjustable lower anchor member 16A may be movablycoupled to the static element 51 and/or movably coupled to the lowertray 14 of a lower element 12. By movably coupling a mobile element 51to a static element 52 and/or to the lower tray 14 of a lower element12, the position of the mobile element 51 relative to the static element52 and/or to the lower tray 14 of a lower element 12 may be changed. Inpreferred embodiments, a mobile element 51 of an adjustable lower anchormember 16A may be movably coupled to the static element 51 and/ormovably coupled to the lower tray 14 of a lower element 12 so that themobile element 51 may be moved in an anterior direction and/or in aposterior direction relative to the mandibular teeth of a patient whichmay be received in the upper tray 13.

Each lower anchor member 16 configured as an adjustable lower anchormember 16A may comprise a lower contact surface 20 which may generallyform the distal surface of the adjustable lower anchor member 16A andwhich may extend from the lower bite plane 18 to the lower tray 14.Preferably, the lower contact surface 20 of an adjustable lower anchormember 16A on a first side of the lower tray 14 may contact the uppercontact surface 19 of an upper anchor member 15, 15A, on a first side ofthe upper tray 13 when the jaw of a patient wearing an oral apparatus100 is closed. The lower contact surface 20 of an adjustable loweranchor member 16A may be formed onto the distal or posterior surface ofthe mobile element 51 of the adjustable lower anchor member 16A. Bymoving the mobile element 51 of an adjustable lower anchor member 16A ina posterior direction, the upper contact surface 19 of the adjustableupper anchor member 15A may be moved in a posterior direction.Conversely, by moving the mobile element 51 of an adjustable loweranchor member 16A in an anterior direction, the lower contact surface 20of the adjustable lower anchor member 16A may be moved in an anteriordirection.

Additionally, each lower anchor member 16 configured as an adjustablelower anchor member 16A may comprise a lower bite plane 18 which mayform the portion of the lower tray 14 that extends farthest from theocclusal surfaces of the mandibular teeth when the lower tray 14 is beengaged to the mandibular teeth. In some embodiments, the lower biteplane 18 of an adjustable lower anchor member 16A may be formed by alower static bite plane 18A and/or a lower mobile bite plane 18B.Generally, a mobile element 51 of an adjustable lower anchor member 16Amay comprise a lower mobile bite plane 18B which may form the portion ofthe mobile element 51 of the adjustable lower anchor member 16A thatextends farthest from the occlusal surfaces of the mandibular teeth whenthe lower tray 14 is be engaged to the mandibular teeth. Likewise, astatic element 52 of an adjustable lower anchor member 16A may comprisea lower static bite plane 18A which may form the portion of the mobileelement 51 of the adjustable lower anchor member 16A that extendsfarthest from the occlusal surfaces of the mandibular teeth when thelower tray 14 is be engaged to the mandibular teeth. Optionally, thelower mobile bite plane 18B and the lower static bite plane 18A mayextend the substantially the same distance from the occlusal surfaces ofthe mandibular teeth when the lower tray 14 is be engaged to themandibular teeth.

In preferred embodiments, the mobile element 51 of an adjustable loweranchor member 16A may be posterior to the static element 52 and thestatic element 52 may be anterior to the mobile element 51. Anadjustable lower anchor member 16A may be positioned proximate to themandibular molar teeth 201 and configured to contact with an upperanchor member 15, 15A, positioned proximate to the maxillary teeth 201,such as to the maxillary second premolar teeth 301P2, to cause themandible to move forwards relative to the maxilla when the mouth is in aclosed position and the adjustable lower anchor member 16A is contactingthe upper anchor member 15, 15A. Portions of the lower contact surface20 of an adjustable lower anchor member 16A farthest from the lower biteplane 18, formed by a lower static bite plane 18A and/or a lower mobilebite plane 18B, may be angled towards the lower bite plane 18 so thatthe lower contact surface 20 may be coupled to the lower bite plane 18at lower medial corner 22 with lower anchor member corner angle 24 thatis between 45 and 135 degrees. In further preferred embodiments, thelower anchor member corner angle 24 of an adjustable lower anchor member16A may be less than or equal to 90 degrees.

Referencing FIGS. 9-14 and in some embodiments, a mobile element 51 maybe movably coupled to a static element 52 with an adjustable fastener61. In further embodiments, an adjustable fastener 61 may be configuredto couple a mobile element 51 to a static element 52 while allowing theposition of the mobile element 51 to be changed relative to the staticelement 52. In still further embodiments, an adjustable fastener 61 maybe configured to couple a mobile element 51 to an upper tray 13 or to alower tray 14 while allowing the position of the mobile element 51 to bechanged relative to the upper tray 13 or lower tray 14. Preferably, anadjustable fastener 61 may allow the mobile element 51 to be movedanterior, or to the front of the mouth, and/or to be moved posterior, orto the back of the mouth, of a patient wearing the oral apparatus 100.

In further embodiments, an adjustable fastener 61 may comprise threadingso that by rotating the adjustable fastener 61 in a first direction themobile element 51 to be moved in an anterior direction and by rotatingthe adjustable fastener 61 in a second direction the mobile element 51to be moved in a posterior direction. By moving the mobile element 51 ofan adjustable upper anchor member 15A, and therefore the upper contactsurface 19, in an anterior direction and/or moving the mobile element 51of an adjustable lower anchor member 16A, and therefore the lowercontact surface 20, in a posterior direction, the mandible may be movedforwards relative to the maxilla when the mouth is in a closed positionand the upper contact surfaces 19 are contacting the lower contactsurfaces 20. By moving the mobile element 51 of an adjustable upperanchor member 15A, and therefore the upper contact surface 19, in aposterior direction and/or moving the mobile element 51 of an adjustablelower anchor member 16A, and therefore the lower contact surface 20, inan anterior direction, the mandible may be moved rearwards relative tothe maxilla when the mouth is in a closed position and the upper contactsurfaces 19 are contacting the lower contact surfaces 20.

As perhaps best shown in FIGS. 13 and 14, in alternative embodiments, anadjustable anchor member 15A, 16A, may comprise any suitable type ofadjustable fastener 61 which may be configured to couple a mobileelement 51 to a static element 52 while allowing the position of themobile element 51 to be changed relative to the static element 52.Optionally, an adjustable anchor member 15A, 16A, may comprise one ormore guide pins 62 which may slidably couple a mobile element 51 to astatic element 52 thereby stabilizing the mobile element 51. The mobileelement 51 may comprise a mobile brace 63 which may be embedded withinthe mobile element 51 and which may slidably receive one or more guidepins 62 and threadedly receive a threaded adjustable fastener 61. Thestatic element 52 may comprise a static brace 64 which may be embeddedwithin the static element 52 and which may also slidably receive one ormore guide pins 62 and threadedly receive a threaded adjustable fastener61.

Preferably, portions of a guide pin 62 may slide freely within a mobileelement 51 and/or a static element 52, such as within a mobile brace 63and within a static brace 64, respectively, while the position of themobile element 51 relative to the static element 52 may be governed byone or more adjustable fasteners 61, such as within a mobile brace 63and within a static brace 64, respectively. In further preferredembodiments, one or more adjustable fasteners 61 and/or guide pins 62may be coupled to a mobile element 51 and/or a static element 52 bybeing molded or formed into the mobile element 51 and/or a staticelement 52. In other embodiments, one or more adjustable fasteners 61and/or guide pins 62 may be coupled to a mobile element 51 and/or astatic element 52 with an adhesive, such as a dental epoxy, or any othersuitable coupling method.

As shown in FIGS. 9 and 11-14, in some embodiments, the apparatus 100may comprise one or more optional upper auxiliary planes 31 and/oroptional lower auxiliary planes 32. A optional upper auxiliary plane 31may extend along the upper tray 13, and an upper anchor member 15 or anadjustable upper anchor member 15A may be positioned on or adjacent toan upper auxiliary plane 31. In some embodiments, an upper auxiliaryplane 31 may be positioned anterior to an upper anchor member 15 or anadjustable upper anchor member 15A as shown in FIGS. 9 and 11. Infurther embodiments, a first upper auxiliary plane 31 may be positionedanterior to an upper anchor member 15 or an adjustable upper anchormember 15A and a second upper auxiliary plane 31 may be positionedposterior to an upper anchor member 15 or an adjustable upper anchormember 15A as shown in FIG. 11. Each upper auxiliary plane 31 maycomprise one or more upper auxiliary surfaces 33 which may contactportions of a lower tray 14, such as a lower bite plane 18, 18A, 18B,when the upper 13 and lower 14 trays are contacting each other tofacilitate the distribution of force between the two.

An optional lower auxiliary plane 32 may extend along the lower tray 14,and a lower anchor member 16 or an adjustable lower anchor member 16Amay be positioned on or adjacent to a lower auxiliary plane 32. In someembodiments, a lower auxiliary plane 32 may be positioned posterior to alower anchor member 16 or an adjustable lower anchor member 16A as shownin FIGS. 9 and 12. In further embodiments, a first lower auxiliary plane32 may be positioned anterior to a lower anchor member 16 or anadjustable lower anchor member 16A and a second lower auxiliary plane 32may be positioned posterior to a lower anchor member 16 or an adjustablelower anchor member 16A as shown in FIG. 12. Each lower auxiliary plane32 may comprise one or more lower auxiliary surfaces 34 which maycontact portions of an upper tray 13, such as an upper bite plane 17,17A, 17B, when the upper 13 and lower 14 trays are contacting each otherto facilitate the distribution of force between the two.

FIG. 15 shows a flow chart of a method of mandibular jaw manipulation(“the method”) 700 according to various embodiments described herein.Preferably, the method 700 may be used to progressively achieve atherapeutic mandibular advancement for a patient or user by wearing anoral apparatus 100. The therapeutic mandibular advancement may bereferred to as the desired progressive mandibular advancement distance(d1) 400.

The method 700 may start 710 and the desired progressive mandibularadvancement distance (d1) 400 may be determined or selected for thepatient in which the lower (mandibular) jaw may be positioned relativeto the upper (maxillary) jaw in a therapeutic bite pattern for a patientin step 720. As shown in FIG. 8, the progressive mandibular advancementdistance (d1) 400 may be described as the distance the lower jaw 200 isto be advanced forward to allow the alignment of the teeth of the upperjaw 300 with the lower jaw 200 to produce a therapeutic bite pattern. Insome embodiments, the desired progressive mandibular advancementdistance (d1) 400 may produce a therapeutic bite pattern which mayposition the lower jaw 200 relative to the upper jaw 300 a requireddistance in order to address the condition of the user. In furtherembodiments, a sleep Physician may make the diagnosis and dispense aprescription for an oral apparatus for snoring or the treatment of SleepApnea to a dentist versed in Dental Sleep Medicine comprising a requireddistance to advance the lower jaw relative to the upper jaw.

Next in step 703, an oral apparatus 100 comprising an adjustable anchormember with a contact surface on a first tray and comprising an anchormember with a contact surface on a second tray may be fabricated. Theoral apparatus 100 may be fabricated first using the 3-D model whichcomprises one or more upper anchor members 15 positioned on an uppertray 13 proximate to one or more maxillary teeth on one or more sides ofthe upper jaw, and one or more lower anchor members 16 positioned on alower tray 14 proximate to one or more mandibular teeth on one or moresides of the lower jaw. In some embodiments, the first tray may comprisethe upper tray 13 and the upper anchor members 15 may be configured asadjustable upper anchor members 15A. Each adjustable upper anchor member15A may comprise an upper contact surface 19 which may be moved bymoving the mobile element 51 of the adjustable upper anchor member 15Aand each upper contact surface 19 may be configured to contact a lowercontact surface 20 of a lower anchor member 16 on the second or lowertray 14. In other embodiments, the first tray may comprise the lowertray 14 and the lower anchor members 16 may be configured as adjustablelower anchor members 16A. Each adjustable lower anchor member 16A maycomprise a lower contact surface 20 which may be moved by moving themobile element 51 of the adjustable upper anchor member 16A and eachlower contact surface 20 may be configured to contact an upper contactsurface 19 of an upper anchor member 15 on the second or upper tray 13.

In alternative embodiments of step 703, an oral apparatus 100 comprisingan adjustable anchor member with a contact surface on a first tray andcomprising an anchor member with a contact surface on a second tray maybe fabricated in which the anchor member on the second tray isconfigured as an adjustable anchor member thereby providing an oralapparatus with one or more adjustable anchor members 15A on the uppertray 13 and one or more adjustable anchor members 16A on the lower tray14.

In step 704, the user or patient may wear the oral apparatus 100 byengaging their maxillary teeth 301 with the upper tray 13 and theirmandibular teeth 201 with the lower tray 14.

In some embodiments, the user or patient may wear the oral apparatus 100in the presence of the dental practitioner associated with or directingthe fabrication of the oral apparatus 100 to allow the dentalpractitioner to observe the amount of mandibular advancement distance(d1) achieved by the contact between the upper 19 and lower 20 contactsurfaces of the oral apparatus 100 when the user or patient closes theirmouth. In further embodiments, the user or patient may wear the oralapparatus 100 for a period of time during which or after which thedental practitioner to observe the amount of mandibular advancementdistance (d1) achieved by the contact between the upper 19 and lower 20contact surfaces of the oral apparatus 100 when the user or patientcloses their mouth.

In decision block 705, it may be determined if the desired mandibularadvancement distance (d1) achieved. In some embodiments, thedetermination if the desired mandibular advancement distance (d1) hasbeen achieved may be completed by an examination by a dentalpractitioner. If the desired mandibular advancement distance (d1) hasbeen achieved, the method 700 may proceed directly to step 707 and themethod 700 may finish.

If the desired mandibular advancement distance (d1) has not beenachieved, the method 700 may proceed to step 706 in which the contactsurface of the adjustable anchor member may be moved. In embodiments inwhich the first tray comprises one or more adjustable upper anchormembers 15A, the upper contact surface 19 of the adjustable upper anchormembers 15A may be moved in an anterior direction to increase themandibular advancement or moved in a posterior direction to decrease themandibular advancement achieved when the upper 19 and lower 20 contactsurfaces are in contact with each other. In embodiments in which thefirst tray comprises one or more adjustable lower anchor members 16A,the lower contact surface 20 of the adjustable lower anchor members 16Amay be moved in an anterior direction to decrease the mandibularadvancement or moved in a posterior direction to increase the mandibularadvancement achieved when the upper 19 and lower 20 contact surfaces arein contact with each other. Optionally, after step 706 the method 700may return to decision block 705 or the method 700 may finish 707.

While some materials have been provided, in other embodiments, theelements that comprise the apparatus 100 such as the upper element 11,lower element 12, upper tray 13, lower tray 14, upper anchor member 15,lower anchor member 16, optional adjustable upper anchor member 15A,optional adjustable lower anchor member 16A, and/or any other elementdiscussed herein may be made from durable dental safe materials such asmetals and metal alloys, hard plastics, fiber reinforced plastics,carbon fiber, resins, polymers or any other suitable materials includingcombinations of materials. Additionally, one or more elements may bemade from or comprise durable and slightly flexible dental safematerials such as soft plastics, silicone, soft rubbers, or any othersuitable materials including combinations of materials. In someembodiments, one or more of the elements that comprise the apparatus 100may be coupled or connected together with heat bonding, chemicalbonding, adhesives, clip type fasteners, rivet type fasteners, threadedtype fasteners, other types of fasteners, or any other suitable joiningmethod. In other embodiments, one or more of the elements that comprisethe apparatus 100 may be coupled or removably connected by being pressfit or snap fit together, by one or more fasteners such as threaded typefasteners, sealable tongue and groove fasteners, snap fasteners, cliptype fasteners, a push-to-lock type connection method, a turn-to-locktype connection method, slide-to-lock type connection method or anyother suitable temporary connection method as one reasonably skilled inthe art could envision to serve the same function. In furtherembodiments, one or more of the elements that comprise the apparatus 100may be coupled by being one of connected to and integrally formed withanother element of the apparatus 100. In yet further embodiments, one ormore of the elements that comprise the apparatus 100 may compriseretention depressions or protrusions which can be added using dentalinstruments or by adding composite to the apparatus 100 to improveretention of the apparatus to the teeth as needed.

Although the present invention has been illustrated and described hereinwith reference to preferred embodiments and specific examples thereof,it will be readily apparent to those of ordinary skill in the art thatother embodiments and examples may perform similar functions and/orachieve like results. All such equivalent embodiments and examples arewithin the spirit and scope of the present invention, are contemplatedthereby, and are intended to be covered by the following claims.

What is claimed is:
 1. An apparatus for adjusting the positionalrelationship between a mandible and maxilla of a mouth, the apparatuscomprising: an upper tray configured to receive a plurality of maxillaryteeth, the upper tray comprising; i. a first upper anchor member coupledto a first side of the upper tray and comprising a first upper contactsurface and a first upper bite plane; ii. a second upper anchor membercoupled to a second side of the upper tray and comprising a second uppercontact surface and a second upper bite plane; iii. a first upperauxiliary plane protruding below the upper tray and having a first upperauxiliary plane surface, the first upper auxiliary plane positionedproximate to the first upper anchor member and the first upper auxiliaryplane surface oriented parallel to the first upper bite plane; iv. asecond upper auxiliary plane protruding below the upper tray and havinga second upper auxiliary plane surface, the second upper auxiliary planepositioned proximate to the second upper anchor member and the secondupper auxiliary plane surface oriented parallel to the second upper biteplane; a lower tray configured to receive a plurality of mandibularteeth, the lower tray comprising; i. a first lower anchor member coupledto a first side of the lower tray, wherein the first lower anchor membercomprises a first lower contact surface and a first lower bite plane,the first lower bite plane configured to contact the first upperauxiliary plane surface of the first upper auxiliary plane; ii. a secondlower anchor member coupled to a second side of the lower tray, whereinthe second lower anchor member comprises a second lower contact surfaceand a second lower bite plane, the second lower bite plane configured tocontact the second upper auxiliary plane surface of the second upperauxiliary plane; and wherein the upper contact surface of the firstupper anchor member is configured to contact the lower contact surfaceof the first lower anchor member and the upper contact surface of thesecond upper anchor member is configured to contact the lower contactsurface of the second lower anchor member while the mouth is in a closedposition to adjust the positional relationship between the mandible andthe maxilla of the mouth.
 2. The apparatus of claim 1, wherein the firstand second lower anchor members each comprise a first width at a portiondistal to the lower tray and a second width at a portion proximal to thelower tray, the first width being wider than the second width.
 3. Theapparatus of claim 1, wherein the upper contact surface and the upperbite plane of the first and second upper anchor members form an uppermedial corner having an upper member corner angle, and wherein the lowercontact surface and the lower bite plane of the first and second loweranchor members form a lower medial corner having a lower member cornerangle.
 4. The apparatus of claim 3, wherein the lower medial cornerangle of both the first and second lower anchor members is less than 90degrees forming an upwardly posterior sloped first and second lowercontact surfaces.
 5. The apparatus of claim 1, wherein the first upperauxiliary plane is positioned between the first upper anchor memberupper bite plane and the upper tray and the second upper auxiliary planeis positioned between the second upper anchor member bite plane and theupper tray.
 6. The apparatus of claim 1, wherein the first upperauxiliary plane surface is positioned between the first upper anchormember and the upper tray and extends away from the first upper anchormember in both an anterior and posterior direction and the second upperauxiliary plane surface is positioned between the second upper anchormember and the upper tray and extends away from the second upper anchormember in both an anterior and posterior direction.
 7. The apparatus ofclaim 1, wherein the first and second upper auxiliary plane surfaces aresubstantially planar.
 8. The apparatus of claim 1, further comprising afirst lower auxiliary plane having a first lower auxiliary plane surfacepositioned on the lower tray proximate to the first lower anchor memberand a second lower auxiliary plane having a second lower auxiliary planesurface positioned on the lower tray proximate to the second loweranchor member.
 9. The apparatus of claim 8, wherein the first lowerauxiliary plane is positioned between the first lower anchor member andthe lower tray and the second lower auxiliary plane is positionedbetween the second lower anchor member and the lower tray.
 10. Anapparatus for adjusting the positional relationship between a mandibleand maxilla of a mouth, the apparatus comprising: a lower trayconfigured to receive a plurality of mandibular teeth, the lower traycomprising; i. a first lower anchor member coupled to a first side ofthe lower tray and comprising a first lower contact surface and a firstlower bite plane; ii. a second lower anchor member coupled to a secondside of the lower tray and comprising a second lower contact surface anda second lower bite plane; iii. a first lower auxiliary plane protrudingabove the lower tray and having a first lower auxiliary plane surface,the first lower auxiliary plane positioned proximate to the first loweranchor member and the first lower auxiliary plane surface orientedparallel to the first lower bite plane; iv. a second lower auxiliaryplane protruding above the lower tray and having a second lowerauxiliary plane surface, the second lower auxiliary plane positionedproximate to the second lower anchor member and the second lowerauxiliary plane surface oriented parallel to the second lower biteplane; a upper tray configured to receive a plurality of maxillaryteeth, the upper tray comprising; i. a first upper anchor member coupledto a first side of the upper tray, wherein the first upper anchor membercomprises a first upper contact surface and a first upper bite plane,the first upper bite plane configured to contact the first lowerauxiliary plane surface of the first lower auxiliary plane; ii. a secondupper anchor member coupled to a second side of the upper tray, whereinthe second upper anchor member comprises a second upper contact surfaceand a second upper bite plane, the second upper bite plane configured tocontact the second lower auxiliary plane surface of the second lowerauxiliary plane; and wherein the lower contact surface of the firstlower anchor member is configured to contact the upper contact surfaceof the first upper anchor member and the lower contact surface of thesecond lower anchor member is configured to contact the upper contactsurface of the second upper anchor member while the mouth is in a closedposition to adjust the positional relationship between the mandible andthe maxilla of the mouth.
 11. The apparatus of claim 10, wherein thefirst and second lower anchor members each comprise a first width at aportion distal to the lower tray and a second width at a portionproximal to the lower tray, the first width being wider than the secondwidth.
 12. The apparatus of claim 10, wherein the lower contact surfaceand the lower bite plane of the first and second lower anchor membersform a lower medial corner having an lower member corner angle, andwherein the upper contact surface and the upper bite plane of the firstand second upper anchor members form a upper medial corner having aupper member corner angle.
 13. The apparatus of claim 12, wherein theupper medial corner angle of both the first and second upper anchormembers is less than 90 degrees forming an upwardly posterior slopedfirst and second upper contact surfaces.
 14. The apparatus of claim 10,wherein the first lower auxiliary plane is positioned between the firstlower anchor member lower bite plane and the lower tray and the secondlower auxiliary plane is positioned between the second lower anchormember bite plane and the lower tray.
 15. The apparatus of claim 10,wherein the first lower auxiliary plane surface is positioned betweenthe first lower anchor member and the lower tray and extends away fromthe first lower anchor member in both an anterior and posteriordirection and the second lower auxiliary plane surface is positionedbetween the second lower anchor member and the lower tray and extendsaway from the second lower anchor member in both an anterior andposterior direction.
 16. The apparatus of claim 10, wherein the firstand second lower auxiliary plane surfaces are substantially planar. 17.The apparatus of claim 10, further comprising a first upper auxiliaryplane having a first upper auxiliary plane surface positioned on theupper tray proximate to the first upper anchor member and a second upperauxiliary plane having a second upper auxiliary plane surface positionedon the upper tray proximate to the second upper anchor member.
 18. Theapparatus of claim 17, wherein the first upper auxiliary plane ispositioned between the first upper anchor member and the upper tray andthe second upper auxiliary plane is positioned between the second upperanchor member and the upper tray.
 19. The apparatus of claim 17, whereinthe first upper auxiliary plane surface is positioned between the firstupper anchor member and the upper tray and extends away from the firstupper anchor member in both an anterior and posterior direction and thesecond upper auxiliary plane surface is positioned between the secondupper anchor member and the upper tray and extends away from the secondupper anchor member in both an anterior and posterior direction.
 20. Theapparatus of claim 17, wherein the first and second lower auxiliaryplane surfaces are substantially planar.